Provider Demographics
NPI:1669267423
Name:LOCKWOOD, JAELIN M
Entity type:Individual
Prefix:
First Name:JAELIN
Middle Name:M
Last Name:LOCKWOOD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 HEIDI CT
Mailing Address - Street 2:
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:MI
Mailing Address - Zip Code:48858-1206
Mailing Address - Country:US
Mailing Address - Phone:906-458-1886
Mailing Address - Fax:
Practice Address - Street 1:110 HEIDI CT
Practice Address - Street 2:
Practice Address - City:MOUNT PLEASANT
Practice Address - State:MI
Practice Address - Zip Code:48858-1206
Practice Address - Country:US
Practice Address - Phone:906-458-1886
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-11
Last Update Date:2025-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist